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Strengthening Primary Healthcare through Participatory Action Research in Northern Districts of Telangana

Project Completed | Closed: 31 March 2026

About

A community-rooted, evidence-driven initiative to understand and address the determinants of health among tribal and rural populations across five districts of North Telangana.
  • Duration: Multi-year, two-phase implementation
  • Geography: 5 districts, North Telangana
  • Lead Implementer: Affordable Quality Health (AQH) / InOrder
  • Grassroots Partner: Indigenous Development Organisation (IDO)
  • Anchor Partner: Vijayavahini Charitable Foundation (supported by Tata Trusts)
  • Focus: Tribal & rural primary healthcare, social determinants of health
  • Methodology: Participatory Action Research (PAR) + mixed-methods studies + IPHS facility assessments
About the Project
Affordable Quality Health (AQH), through its institute InOrder, implemented the Strengthening Primary Healthcare through Participatory Action Research (SPH-PAR) initiative in five northern districts of Telangana, with grant support from the Vijayavahini Charitable Foundation (supported by Tata Trusts) in partnership with the Indigenous Development Organisation (IDO).
The project set out to answer a question that sits at the heart of equitable healthcare in India: Why does a persistent gap remain between the health needs of tribal communities and their health-seeking behaviour and what would it take to close it?
SPH-PAR used Participatory Action Research to design interventions with communities, placing the lived experience of the Koya, Lambadi, and migratory Gutti Koya tribes, alongside non-tribal rural population at the centre of the evidence base. The findings were then translated into prototype interventions, training programmes, referral pathways, and behaviour-change communication tools aligned with the public health system.
The next phase of work focuses on dissemination, academic publication and policy advocacy.
The tribal regions of North Telangana face a compounded set of health challenges: remote geography, monsoon-driven inaccessibility, seasonal labour migration, socio-cultural distance from formal health services, and infrastructure gaps in frontline facilities. Conventional supply-side fixes alone (adding equipment, posting staff, building centres) have repeatedly failed to translate into improved health outcomes because they don’t address the determinants that shape whether, when, and how a person seeks care.
SPH-PAR was designed on a premise: if we want to strengthen primary healthcare in these districts, we must first listen, systematically, respectfully, and with the right methodology, and then build with the community, not around it.
The project was implemented across five districts of North Telangana, chosen for their high tribal population share and the persistence of access and outcome gaps in primary care:
  • Bhadradri Kothagudem: Primary PAR district (deepest community engagement)
  • Komaram Bheem Asifabad
  • Mulugu
  • Mancherial
  • Jayashankar Bhupalpally

    • Communities engaged:
  • State tribes: Koya, Lambadi
  • Migratory tribes: Gutti Koya
  • Rural non-tribal and other tribal populations
The project was implemented in two phases. The first phase focused on Participatory Action Research (PAR) in Bhadradri Kothagudem district, followed by cross-sectional quantitative and qualitative studies across the five districts. Facility assessments were also conducted across different levels of the public healthcare system, from Health and Wellness Centres to district hospitals, in line with IPHS norms. In addition, Special Newborn Care Units (SNCUs), Nutrition Rehabilitation Centres (NRCs), and District Early Intervention Centres (DEICs) were assessed separately to identify gaps and opportunities for strengthening services.

The second phase focused on designing and piloting practical, community-led interventions to address the challenges identified through the research. In collaboration with the Indigenous Development Organization (IDO), which works closely with tribal communities, the project implemented initiatives to strengthen primary healthcare delivery in tribal regions. Capacity-building activities were conducted for staff at DEICs and SNCUs. The healthcare personnel from government facilities and Indigenous Development Organization (IDO) were trained on referral pathways, and gender in healthcare.

The project also developed Social and Behaviour Change Communication (SBCC) materials on nutrition, maternal health, and child health, along with training materials for community health workers. Stakeholder engagement was strengthened through workshops involving public health experts, healthcare providers, and government stakeholders. In addition, documentary videography was undertaken to capture project activities, partnerships, and community impact for dissemination and advocacy purposes.
The research explored a wide spectrum of determinants shaping health outcomes and health-seeking behaviour in tribal regions:
  • Water quality and access
  • Menstrual hygiene
  • Electricity and infrastructure
  • Substance use
  • Access to healthcare facilities and transport
  • The role of traditional birth attendants
  • Community beliefs and cultural practices
  • Language and communication barriers
  • Seasonal labour and migration patterns
  • Nutrition and food security
By project closure, SPH-PAR produced and submitted:
  • Comprehensive research and assessment reports: community surveys, in-depth interviews, FGDs.
  • IPHs-benchmarked facility assessment reports across HWCs, PHCs, CHCs, DHs, SNCUs, NRCs, and DEICs.
  • Six documented referral care pathways with associated training modules.
  • Training modules for CHWs, DEIC/SNCU/RBSK staff, and IDO healthcare personnel.
  • SBCC modules on nutrition, maternal health, and child health.
  • Prototypes for health systems strengthening ready for scale-testing.
  • Service-utilisation and equipment-utilisation monitoring frameworks for MMUs and facilities.
  • Documentary films capturing both phases of the project.
  • Four external stakeholder workshops with experts and government bodies.
Challenge Mitigation
Limited community availability due to occupational and seasonal commitments
  • Scheduled survey visits and FGDs during times suitable for community members (early morning or late evening).
  • Informed the village head and community members in advance to ensure their availability and participation in the survey.
Overlapping field activities and tight operational timelines. Simultaneous implementation of surveys, FGDs, facility assessments, and trainings led to delays in report development and completion of certain activities.
  • Developed a comprehensive field activity calendar to streamline operations.
  • Rigorous coordination meetings between field and office teams.
  • Optimized resource allocation and task sequencing.
Monsoon and poor accessibility in remote tribal areas. Heavy rainfall and poor road connectivity delayed PAR FGDs and field data collection in interior regions.
  • Adopted flexible scheduling based on weather conditions.
  • Utilized downtime for data analysis and reporting tasks.
  • Provided revised travel plans and logistical support to field teams.

With the project formally closed, SPH-PAR enters its dissemination and influence phase:

  • Academic publications of findings to contribute to the global evidence base on tribal primary healthcare.
  • Consolidated reports to inform evidence-based decision-making by state and national stakeholders.
  • Policy advocacy drawing on the six referral pathways, SBCC modules and facility-assessment findings.
  • Cross-sector collaboration on culturally sensitive, community-led models, emphasizing language inclusivity, local storytelling, and sustained engagement, as flagged at the Hyderabad review workshop.